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Behandlungsstrategien bei Azetabulumfrakturen

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Frakturen des Azetabulums stellen seltene Gelenkverletzungen dar, deren erfolgreiche Behandlung sowohl eine diagnostisch-analytische als auch therapeutische Herausforderung darstellt. Die sorgfältige Differenzialindikation wird von einer ausgefeilten, international anerkannten Klassifikation abgeleitet, die Einzelzuordnung bestimmt den nachfolgenden, anspruchsvollen Zugangsweg im Falle der Entscheidung zur Operation. Der postero-laterale Zugang nach Langenbeck und der ilioinguinale Zugang nach Letournel ermöglichen jeweils differente, gut umschriebene Frakturstabilisierungen. Typische Komplikationen bei ersterem Zugang sind periartikuläre Ossifikationen sowie Ischiadikusläsionen, bei letzterem Zugang v. a. die Läsion des N. cutaneus femoris lateralis. Die erweiterten Zugänge mit ihren ausgeprägten Weichteilmobilisationen aggravieren das Komplikationspotenzial und sind daher nur speziellen Indikationen vorbehalten. Die Rekonvaleszenz gestaltet sich meistens langwierig, das längerfristige funktionelle Ergebnis und auch das Arthroseausmaß spiegeln das variationsreiche Zusammenspiel dieser komplexen sowohl traumabedingten als auch iatrogenen Einflussfaktoren wider.

Abstract

Fractures of the acetabulum are seldom joint injuries and their successful therapy encompasses a diagnostic-analytic as well as operative-therapeutic challenge. The careful differential indication is derived from a well-conceived, internationally established classification, and the individual distribution determines the subsequent sophisticated approach in the case of operation. The posterolateral approach according to Kocher-Langenbeck and the ilioinguinal approach according to Letournel enable specific and well-defined stabilization of the fracture. Typical complications with the first approach are periarticular ossifications and ischiatic lesions and with the second approach especially lesions of the cutaneous femoris lateralis nerve. The extended approaches aggravate the possibility of complications with their marked mobilization of soft tissue and are therefore restricted to special indications. Convalescence takes longer, and the long-term functional result as well as the extent of arthrosis reflect the variable interconnection of these complex traumatic and iatrogenic factors.

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Correspondence to Wolfgang Ditzen.

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Ditzen, W., Börner, M. Behandlungsstrategien bei Azetabulumfrakturen. Trauma Berufskrankh 5, 83–91 (2003). https://doi.org/10.1007/s10039-003-0706-3

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